Friday, July 17, 2009

Chester the chocolate lab died this week. I first met Chester when I was shuttling my youngest back and forth to the rural farm where she took riding lessons. The lane from the "hard road" to the barn was fairly long, and Chester ran full tilt toward the car's front wheels. It was only after this scene repeated itself every trip that I realized this was no usual creature. He was dumb. He did not seem to comprehend that a 3000 lb metal monster could possibly hurt him. After all, this nice young girl always was inside it, ready to give the horses (and the dogs) treats! With apologies to the dog in the currently popular movie, I truly believe Chester to be the dumbest dog in the world, or at least in the top (bottom?) 2%. His owners agree.

Sometimes, as I would be sitting in the car, windows down, waiting for the lesson to end and my daughter to emerge, Chester would leap around and chase unseen things. I personally think he may have had doggie schizophrenia, and was following "voices", but the owners said he liked chasing insects. When he tired of this activity, he would almost always top off his romp with a leg raised and a bodily function performed on one of my tires.

The lessons were twice a week, and my wife and I would trade shuttle duties, so I didn't really spend all that much time with this critter. I was surprised, then, at how badly I felt when I learned that Chester had been (you guessed it) run over by a car and killed. He wasn't that old, certainly not very slow, and the driver clearly had no fault in the accident. This dog, however dumb, was always very happy and energetic, and was, in fact, the quintessential dog: slobbering, unashamedly loving all God's fellow creatures, living or inanimate. It pains me to believe that unconditional love that strong has left this world.

It also reminds me that, like so very many of us, Chester died the way he lived. I have had multiple experiences of patients who live in houses where I am certain there is no electricity or running water, and conditions for their end of life care are less than optimal, but they love their lives for what they are, not expecting anything different. Or those whose lives have been lived "in the fast lane", and they die there as well. Those who deny they will ever die, and struggling to the last breath, and those who surround themselves with chaos during their lives so why would we expect anything less in dying?

Another three creatures died in my yard today. A small bird had built a nest in a window box. We discovered this fact when the mother bird flew out as we were watering. The nest was quite small, and difficult to see, but we watched it and indeed, saw three eggs. A great wind blew the whole box over today, and the hatchlings did not survive the fall. This, too, struck me in places inside myself that I didn't expect it to. How unfair! How tragic! Poor helpless defenseless birds. Yet these, too, died as they lived...in a precarious situation the mother bird chose for them.

My favorite newscaster of all time died today. I don't know the details other than he was 92, and had been near death at least for the week since the whole Michael Jackson and Farrah Fawcett debacle. But if he, too, died as he lived, his last words could very well have been, "And that's the way it is, Friday, July 17, 2009"

Sunday, July 5, 2009

I was at the gym yesterday, on the 4th of July. Independence Day. While on the elliptical, the TV had ESPN on, and being that it was 70 years ago that day that Lou Gehrig made his famous farewell speech, they were showing some of the details of his life's story. I don't typically watch ESPN, but thought it was worth a look, given that the disease that carries this man's name is one of the more common that I see in hospice patients. Now, I haven't done any research on what was said, but it struck a chord with me. Lou was apparently diagnosed at Mayo Clinic. Not much was known about the disease at that time (though I'm not sure a lot has changed in 70 years...more on that later). The show went on to talk about how, after his retirement from the game he loved, the man sincerely believed that he would get well. His wife and his doctor from Mayo carried on a correspondence in which they conspired to keep the truth from him so as to "not take away his only hope". Lou also wrote to the doctor, describing people he had met who "got better", yet the doctor did not even tell the man that those he was describing had a different condition. It wasn't until very late in his disease that his letters reflected a knowledge of the inevitable truth. He faced that truth with character and strength, and I deeply wonder what would have been different for this man had his family and his doctor been truthful.

Fast forward 70 years. I had a call from a patient later that day. She has a complicated illness about which I will spare you the details. She is very much ready to die, but her family is most definitely NOT ready to let her go. There is, thankfully, in this case, no "conspiracy of silence" as I see in some families with differences of opinions, and as was seen in Lou Gehrig's case, but there is clearly a conflict of feelings. I am certain these feelings have very deep roots, who knows on what basis. Anyway, the patient wanted to stay home and let nature take its course, yet the family wanted to take her to the hospital for treatment "in case there was something that could be done". The patient, though it was not what she might have otherwise chosen, wanted to make sure her family's wishes were followed, and agreed to go in to be checked out. Her family's feelings were more important to her than her own wishes.

I don't think a lot has changed in 70 years. We still can't cure ALS, Lou Gehrig's disease. Patients may live a bit longer now with better general medical care, and hopefully their death is more comfortable now with good palliative and hospice care. Families and doctors still don't want to take away hope, though thankfully now some are realizing that hope is so much more than hope for a cure, and that honesty, while difficult, is the best course in discussing prognosis.

July 4th. Independence Day. 70 years ago, a giant of a man bravely faced an illness he didn't understand. Yesterday, a giant of a lady faced an illness she didn't understand. Both placed the needs of others ahead of their own. Both will ultimately share the same fate, as will we all. I pray that we honor those who have given their lives for the freedom of this country, and those who have dedicated their lives to others, and all those who have faced or are facing the final chapters of their lives.

About this Blog

The main reason I write this is to share these stories. Hospice has been called "Medicine's greatest secret". This is my humble contribution to changing that fact.

The stories here are all true. The detail may be altered in order to maintain privacy and confidentiality. The changes made do not alter the facts of the stories, only characteristics that I think could lead them to be linked directly to the people involved.

Oh, and the Standard Disclaimer: I work for a healthcare organization, but what you see here is mine alone, and does not represent the views of my employer.

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About Me

I was in a traditional office practice of Family Medicine for 19 years, then found my passion, which is Hospice and Palliative Care. I have been working full time in that area since 2004, doing house calls and administative work. I am now leading efforts to develop and support programs for a Catholic Healthcare System related to these areas.